A Narrative Study of Patient Encounter Accounts of Physicians, Nurses, and Medical Receptionists after Two Decades of a Paradigm of Patient-Centered Care

Despite recent well-known advancements in patient care in the medical fields, such as patient-centeredness and evidence-based medicine and practice, there is rather less known about their effects on the particulars of clinician-patient encounters. The emphasis in clinical encounters remains mostly on treatment and diagnosis and less on communicative competency or engagement for medical professionals. The purpose of this narrative study was to explore interactive competencies in diagnostic and therapeutic encounters and intake protocols within the context of the physicians’, nurses’, and medical receptionists’ perspectives and experiences. Literature on narrative medicine, phenomenology and medicine, therapeutic relationships, cultural and communication competency, and non-Western perspectives on human communication provided the guiding theoretical frameworks for the study. Three data sets including 13 participant interviews (5 physicians, 4 nurses, and 4 medical receptionists), policy documents (physicians, nurses, and medical receptionists) and a website (Communication and Cultural Competency) were used. The researcher then engaged in triangulated analyses, including N-Vivo, manifest and latent, Mishler’s (1984, 1995) narrative elements and Charon’s (2005, 2006a, 2006b, 2013) narrative themes, in recursive, overlapping, comparative and intersected analysis strategies. A common factor affecting physicians’ relationships with their clients was limitation of time, including limited time (a) to listen, (b) to come up with a proper diagnosis, and (c) to engage in decision making in critical conditions and limited time for patients’ visits. For almost all nurse participants in the study establishing therapeutic relationships meant being compassionate and empathetic. The goals of intake protocols for the medical receptionists were about being empathetic to patients, being an attentive listener, developing rapport, and being conventionally polite to patients. Participants with the least iv amount of training and preparation (medical receptionists) appeared to be more committed to working narratively in connecting with patients and establishing human relationships as well as in listening to patients’ stories and providing support to narrow down the reason for their visit. The diagnostic and intake “success stories” regarding patient clinical encounters for other study participants were focused on a timely securing of patient information, with some acknowledgement of rapport and emapathy. Patient-centeredness emerged as a discourse practice, with ambiguous or nebulous enactment of its premises in most clinical settings.

"I'm a better manager":A biographic narrative study of the impact of personal trauma on the professional lives of managers in the UK

This doctoral study aims to understand how experiences of critical illness or bereavement affect the way managers view and approach their work and their relationships at work. This is an interpretative phenomenological study examining the subjective meanings of personal experience and is underpinned by biographic narratives from four participants and interviews with their nominated workplace witnesses (i.e. colleagues who worked alongside the individual at the time of their trauma). As a consequence of the findings that have emerged across this study, three contributions to theory are presented. All four participants described their traumas as a professional growth experience for themselves as managers, which resulted in self-reported and observed behaviour change at work. Consequently, the first area of theoretical contribution is a suggested extension to the post-traumatic growth (PTG) framework (Calhoun & Tedeschi, 2006) with the addition of a new behavioural dimension called ‘managerial growth’, when applied to the context of ‘ordinary’ organizations. The second area of theoretical contribution arose through the reflexive process that was created during data collection where participants and their witnesses remembered episodes of compassion interaction at work. The second area of contribution thus seeks to extend the existing model of compassion at work (Dutton, Worline, Frost and Lilius, 2006), by conceptualising compassion as a dyadic process between a compassion ‘giver’ and a compassion ‘receiver’ in which the compassion receiver ‘trusts or ‘mistrusts’; ‘discloses’ or ‘withholds’; ‘connects’ or ‘disconnects’ with the compassion giver. The third area of contribution is a new conceptualisation of reflexivity, ‘three-dimensional reflexivity’ (3DR) (Armstrong, Butler and Shaw, 2013). 3DR brings together three of the elements that have been missing from critically reflexive management research; by working with multiple variants of reflexivity in the same study; surfacing different reflexive voices to guard against the researcher’s (potentially) solipsistic own; and remaining sensitive to the concept of reflexive time. In doing so, 3DR not only provides a deeper understanding of individual lived experience; it is also a vehicle in which self-insight is gained. Furthermore, by engaging in its practice, those involved in this study have developed both personally and professionally as a result.

Towards Empowerment: Narrative Study of Counselling Psychology Trainees and How They Make Sense of Their Personal and Professional Development in the Context of Their Past Experiences

The discipline of counselling psychology continues to grow and change in response to social, economic and political pressures. It has been argued that its quest for a coherent and distinct identity, which emphasises the possibility of the coexistence of multiple approaches, creates an inherently uncertain and dilemmatic training environment that may hinder the development of trainees’ professional identities. In order to gain a deeper understanding of the issue at hand, the aim was to explore how final year trainees and newly qualified counselling psychologists constructed and made sense of their emerging professional identities and what experiences, past and present, they drew upon in the context of their training to shape those identities. Applying narrative inquiry to analyse eight open-ended interviews, eight preliminary themes were originally identified in participants’ narratives, which with further refinements lead to stories of struggle and marginalisation, growth and discovery, and power and resilience. Participants’ stories of struggle and marginalisation emerged in reference to early family dynamics and stressful life experiences, which seemed to also foster a strong identification with the counselling psychology profession, while stories of growth and discovery focused on the importance of having supportive figures, who helped to instill a sense of security and create an atmosphere of openness. It was in this learning environment that participants felt it was possible to develop a more resilient, empowered professional self, which allowed them to shed an earlier sense of struggle and vulnerability. However, where more of an emphasis was placed on power and resilience, there seemed to be less room for participants to express other feelings that came into conflict with their preferred sense of professional self. While there seems to be a need for a ‘safer’ climate, in which trainees could voice and acknowledge anxieties, vulnerabilities and limitations, addressing concerns around power and vulnerability that may be contributing to the silencing of particular voices and identities may be equally important if trainees are to develop coherent and distinct counselling psychologist identities.

Bullying in the Same-Sex Friendships of Young Adolescent Girls: A Qualitative Study

This qualitative, narrative study explored the bullying experiences of young adolescent girls within their same-sex dyadic and group friendships. The participants were 5 female students, ages 11 and 12 years old, from 1 private, religious school in southern Ontario. Each girl participated in an audiotaped, 30-minute, personal interview based on an unstructured interview protocol. Interview transcripts were analyzed for bullying behaviors using Marini and Dane's (2008) subtypes of bullying, including the form, function, and involvement in bullying. Interview transcripts were also analyzed for common and emerging themes using aspects of L. M., Brown and Gilligan's (1992) "Listener's Guide." The findings of this study suggested that within their same-sex friendships girls assume the roles of all participants in bullying, including bullies, victims, bystanders, and bully-victims. The findings also suggested that bullying behaviors within young adolescent girls' same-sex friendships are mainly indirect in their mode of attack and that they are both proactive and reactive. The bully behaviors identified in this study were used to inform the major themes or salient features within the dynamics of girls' same-sex friendships also identified. These themes included acceptance, intimacy, negotiation, inclusion/exclusion, moral character judgements, and power. The findings of this study will be used to inform current theory, personal and professional practice, as well as future research.

A Narrative Inquiry of Women in Administration: Their Voices Heard

This narrative study examined women’s experiences in leadership positions in an educational setting in Southern Ontario. Semi-structured interviews with 4 women (2 principals and 2 vice principals) revealed 4 key themes: (a) considerations prior to entering into leadership and confidence instilled by others to continue on that path; (b) ongoing challenge of maintaining work−life balance; (c) others’ perceptions of women in leadership positions; and (d) increasing number of women in leadership positions. The researcher used feminist standpoint theory to analyze data collected during interviews, which gave voice to the study’s participants and shed some light on women’s gendered experiences in leadership positions. Findings suggest that historical roots significantly influence society to continue with stereotypical gender roles, though some participants have overcome certain stereotypes. The literature review and participants’ experiences suggest that women have made some progress throughout history yet society needs to remain vigilant while striving for gender equality.

Analyse sémio-narrative d'un corpus de contes merveilleux du Québec

Ce mémoire propose une analyse sémio-narrative d’un corpus de dix-neuf contes merveilleux recueillis auprès des conteurs canadiens-français et canadiens-hurons par l’anthropologue Charles-Marius Barbeau, au début du XXe siècle. Après avoir passé en revue les principales théories dans l’approche sémiotique du conte à partir de Vladimir Propp jusqu’à nos jours, nous avons procédé à une étude narrative du corpus selon la méthode du grand folkloriste russe : cela nous a permis d’en montrer la valeur exceptionnelle mais aussi les limites. Nous avons constaté ainsi que le travail sur un corpus inédit peut mener à l’identification de nouveaux éléments dans la structure du conte merveilleux. En poursuivant nos recherches sur les dix-neuf contes recueillis par Barbeau, nous sommes passée du schéma linéaire, syntagmatique de Propp aux modèles logiques de ses continuateurs, particulièrement celui élaboré par Guy Laflèche. Nos analyses ont mis en évidence non seulement le fait que la structure en miroir est un modèle valide auquel une partie des contes merveilleux se plie parfaitement (d’emblée l’exclusivité du schéma de Propp est mise en question, sinon infirmée), mais aussi que tout conte merveilleux est exceptionnellement organisé, structuré (ce qui confirme la théorie de Claude Bremond conformément à laquelle le récit narratif est une alternance de dégradations et d’améliorations). Enfin, la dernière partie du mémoire est une analyse sémio-discursive de notre corpus qui, au lieu d’être une simple accumulation de listes de mots, d’expressions et de figures, tente d’aborder la structure idéologique, grâce à une étude en parallèle d’un conte du corpus et de deux versions littéraires.

Is There a Role for Narrative Attributes in Scientific Literature?

Thesis (Master's)--University of Washington, 2016-06

Un discours persuasif : Étude narrative de L'Auberge et Le Horla – deux contes fantastiques de Guy de Maupassant

Ce mémoire se compose d’une analyse narrative de deux nouvelles fantastiques par Guy de Maupassant : L’Auberge et la seconde version du Horla. La narration du premier de ces contes est extradiégétique, ce qui signifie que le narrateur se trouve en dehors de l’univers fictif. Le deuxième texte, en revanche, est un exemple d’une narration intradiégétique – le narrateur est donc un personnage du récit. Le but principal de l’étude est d’examiner comment le discours du narrateur, selon qu’il est extradiégétique ou intradiégétique, influence la perception des récits et des protagonistes. Pour atteindre cet objectif, nous identifions d’abord quelques stratégies narratives qui sont employées dans les nouvelles afin d’évoquer l’hésitation du lecteur et ainsi créer l’effet fantastique. Nous observons que, suivant le mode de la narration, extradiégétique ou intradiégétique, les stratégies narratives utilisées sont de différentes natures. Elles coopèrent toutefois pour créer un sentiment d’hésitation au lecteur et conduisent donc celui-ci à considérer l’existence du surnaturel dans le monde diégétique. Enfin, nous montrons de plus près comment le discours du narrateur influence la manière dont le lecteur considère le comportement des personnages principaux ainsi que leur santé mentale. Nous voyons que dans tous les deux textes, il n’y a aucun doute que le protagoniste devient finalement fou. Cependant, tandis que le savoir du narrateur omniscient aide enfin le lecteur à résoudre le mystère fantastique dans L’Auberge, le mystère n’est jamais résolu dans Le Horla. Cela semble être attribué à la perception et au savoir limité du narrateur intradiégétique.

Infância Institucionalizada: Narrativas das crianças sobre o antes, o durante e o pós alta hospitalar

Dissertação apresentada à Escola Superior de Educação de Lisboa para a obtenção do grau de Mestre em Ciências da Educação, especialização em Educação Social e Intervenção Comunitária

Exploring the personal and professional lives of teachers in the search for authenticity /

"We teach who we are" (Palmer, 1998, p. 2). This simple, yet profound, statement was the catalyst that began my thesis journey. Using a combination of self-study and participant narratives, Palmer's idea was explored as search for authenticity. The self-study component of this narrative was enhanced by the stories of two other teachers, both women. I chose to use narrative methodology to uncover and discover the relationship between the personal and professional lives of being a teacher. Do teachers express themselves daily in their classrooms? Do any lessons from the classroom translate into teachers' personal lives? The themes of reflection, authenticity, truth, and professional development thread themselves throughout this narrative study. In order to be true to myself as a teacher/researcher, arts-based interpretations accompany my own and each participant's profile. Our conversations about our pasts, our growth as teachers and journeys as individuals were captured in poetry and photographic mosaics. Through rich and detailed stories we explored who we are as teachers and how we became this way. The symbiotic relationship between our personal and professional lives was illustrated by tales of bravery, self-discovery, and reflection. The revelations uncovered illustrate the powerful role our past plays in shaping the present and potentially the friture. It may seem indulgent to spend time exploring who we are as teachers in a time that is increasingly focused on improving student test scores. Yet, the truth remains that, "Knowing myself is as crucial to good teaching as knowing my students and my subject" (Palmer, 1998, p. 2).

Breaking the silence : exploring the workplace experiences of six women with learning disabilities

In the current economic climate, employees are expected to upgrade their skills in order to remain productive and competitive in the workplace, and many women with learning disabilities! may feel doubly challenged when dealing with such expectations. Although the number of people with reported learning disabilities who enter the workforce is expected to increase, a dearth of research focuses on work-related experiences of women with learning disabilities; consequently, employers and educators often are unaware ofthe obstacles and demands facing such individuals. This qualitative narrative study sheds light on the work experiences of women with diagnosed or suspected learning disabilities. The study used semistructured interviews to explore their perspectives and reflections on learnlng in order to: (a) raise awareness of the needs of women with learning disabilities, (b) enhance their opportunities to learn in the workplace, and (c) draw attention to the need for improvement of inclusiveness in the workplace, especially for hidden disabilities. Study findings reveal that participants' learning was influenced by work relationships, the learning environments, self-determination, and taking personal responsibility. Moreover, the main accommodation requested was to have supportive and understanding work relationships and environments. Recommendations are made for future research and workplace improvements, most notably that no employees should be left behind through an employee-centered approach.

Dickens, Hogarth and artistic perception: the case of Nicholas Nickleby

This essay considers the interest shared by William Hogarth and Charles Dickens on the idea of instrumentality in the art of realism. Taking his cue from eighteenth-century epistemological philosophy, Hogarth developed an idea of beauty and realism as insisting upon the need for human subjectivity or perspective. Naïve realism was a style that troubled both Hogarth and Dickens and both men developed forms in which caricature, melodrama and exaggeration is crucial to the development of verisimilitude. Considering the progress pieces and the writings of Hogarth as a preface to the style of Dickens, I argue that Nicholas Nickleby developed an extraordinary self-reflexivity. Both Nicholas and his uncle Ralph form part of a narrative study of the implications of filtering perception through the distorting lens of the individual.

Inovação na licenciatura: cartografando uma reforma curricular

Este estudo narrativo centra-se na formação de professores nos cursos de licenciatura, e parte dos elementos que caracterizam e significam o processo de reforma curricular do curso de licenciatura em Ciências Biológicas da Universidade Federal do Pará, ocorrido durante o ano de 2000, no bojo das reformas educativas em curso no cenário brasileiro. Busco, nesse contexto, pela análise reflexiva, investigar para compreender a construção de um conjunto de inovações curriculares na formação inicial de professores de ciências e biologia que atuarão na educação básica do sistema de ensino brasileiro e regional. Tais ações se consubstanciam na apresentação, na discussão e no debate de aspectos internos e externos do referido processo, da proposição e implementação do projeto da reforma para o curso em questão, a partir das vozes de um grupo de professoras que dele participaram, das representações dos alunos contemplados na reforma, e também de documentos pertinentes ao momento. Aponto, de modo particular, avanços significativos no que concerne às mudanças qualitativas empreendidas, as quais são observadas na construção de saberes docentes por parte dos alunos em processo de formação, sendo algo atingível na prática de professores formadores, no âmbito deste curso. Desse modo, o estudo guarda contribuições relevantes na investigação e na reflexão atual no campo da formação inicial de professores de ciências e biologia, de modo particular, e da formação de professores nas demais licenciaturas, de modo geral.

Narrativas audiovisuais nas redes sociais: o consumo como elemento de identidade na campanha da Panvel

Pós-graduação em Comunicação - FAAC